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Identifier 000447789
Title Έκβαση ασθενών με ανθεκτική υποξυγοναιμία(PaO2/FiO2< 100 mmHg) που πληρούν κριτήρια θεραπείας με ECMO σε κέντρο χωρίς διαθεσιμότητα ECMO. : μονοκεντρική μελέτη 5 ετών
Alternative Title Outcome of patients with refractory hypoxemia (PaO2/FiO2< 100 mmHg) meeting criteria for ECMO in a center without ECMO facilities. A 5-years retrospective single-center study
Author Κόκκινος, Νικόλαος
Thesis advisor Κονδύλη, Ευμορφία
Reviewer Βαπορίδη, Αικατερίνη
Abstract Background: Patients with acute respiratory failure requiring admission to the ICU may develop severe and persistent hypoxia, despite the use of protective invasive mechanical ventilation. The various strategies for treating persistent hypoxia have been extensively studied. Veno-venous extracorporeal membrane oxygenation (ECMO) is a helpful intervention in patients with severe refractory hypoxemia either because mechanical ventilation cannot ensure adequate oxygenation or because lung protective ventilation is not feasible. However, ECMO is a highly invasive procedure with several, potentially devastating complications and its implementation is complex and expensive Objective: The aim of this study is to determine the efficacy of treating persistent hypoxemia, which meets criteria for ECMO, in a center without ECMO facilities. The sub-objectives included the outcome of patients with refractory hypoxemia, as well as the various interventions performed and their potential impact on persistent hypoxia. Methods: This is a single-center, retrospective observational study in patients with severe refractory hypoxemia who were hospitalized in the ICU of PAGNI during the period January 2017 – March 2021. Demographic, clinical, medication or other treatments were recorded in, order to correlate these parameters with patient outcome. The data were entered in an electronic record sheet EXCEL and their statistical analysis was performed using SPSS 26. Results: 2097 patients were hospitalized during this period in the ICU, of whom 604 had at least one episode with a PaO2/FiO2 ratio <150mmHg. The patients who finally met the inclusion criteria and were screened to find potential candidates for ECMO application were 149. The number of the final candidates was 47 and they could potentially be treated with ECMO. Of all these patients, those who finally survived and completed their treatment (survivors) were 55.3%, while non - survivors were 44.7%. The most common cause of hypoxia was ARDS, mainly due to a respiratory infection or septic shock. The most used ventilation mode was the Volume Control (VC), as it was applied to 57.6% of survivors and 71.4% of non-survivors. 70.2% of the candidates had a contraindication for treatment with ECMO. Of the total survivors, 57.6% had a contraindication to ECMO, while among non-survivors the corresponding percentage was 85.7%. Main causes of contraindication for ECMO treatment were, age> 65 years (70%), inability to receive anticoagulants (12%), severe or irreversible brain disease (18%). Various therapeutic interventions were studied. Prone position was applied to 36.1% of ECMO treatment candidates, 42.3% of survivors and 28.5% of non - survivors. Bronchoscopy was performed on 19% of all candidates. Recruitment maneuvers were always performed before the application of any other intervention (e.g., increasing the PEEP or prone positioning). Increase in PEEP applied in 28.5% of the survivors and in 53.8% of non - survivors. Finally, neuromuscular blocking agent was administered to 46.8% of candidates for ECMO treatment. There were no statistically significant differences in the parameters studied, between survivors and non – survivors (p > 0.05). Conclusion: In the present study it was shown that only a very small percentage of patients (29%) with severe refractory hypoxemia would eventually be candidates for treatment with ECMO. Of all the candidates, the percentage that finally survived with the implementation of simple and non-invasive therapeutic options, was 55.3%. Of all non - survivors, 85.7% were not eligible for ECMO anyway due to the existence of a contraindication. Finally, out of 604 patients with moderate to severe ARDS, only 24.6% of them developed severe and persistent hypoxia. The ICU, where this research conducted, is a center without ECMO facilities. Thus, patients with moderate to severe ARDS are treated with less invasive and possibly equally effective strategies. Individualized mechanical ventilation is applied, based on the physiology of the respiratory system of each patient. ECMO should be a therapeutic intervention in selected patients with severe ARDS and refractory hypoxemia to optimal ventilation, and these patients should be referred to specialized centers.
Language Greek
Issue date 2022-03-30
Collection   School/Department--School of Medicine--Department of Medicine--Post-graduate theses
  Type of Work--Post-graduate theses
Permanent Link https://elocus.lib.uoc.gr//dlib/4/2/b/metadata-dlib-1651231092-583673-21818.tkl Bookmark and Share
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